Waist circumference but not body mass index predicts long-term mortality in elderly subjects with chronic heart failure

Objectives: To examine whether waist circumference (WC) and body-mass index (BMI) can predict long-term mortality in elderly subjects with and without chronic heart failure (CHF). Design: Longitudinal evaluation with a 12-year follow-up. Setting: Campania, a region of southern Italy. Participants: One thousand three hundred thirty-two subjects aged 65 and older selected from the electoral rolls of Campania. Measurements: The relationship between WC or BMI and mortality during a 12-year follow-up in 125 subjects with and 1,143 subjects without CHF. Results: Mortality increased as WC increased in elderly subjects without CHF (from 47.8% to 56.7%, P=.01), and the increase was even greater in patients with CHF (from 58.1% to 82.0%, P=.01). In contrast, mortality decreased as BMI increased in elderly subjects without CHF (from 53.8% to 46.1%, P0 =.046) but not in those with CHF. According to Cox regression analysis, BMI protected against long-term mortality in the absence but not in the presence of CHF. In the absence of CHF, WC was associated with a 2% increased risk of long-term mortality for each 1-cm greater WC (Hazard Ratio (HR)=1.02, 95% confidence interval (CI)=1.01-1.03; P<.001), versus 5% increased in the presence of CHF (HR=1.06, 95% CI=1.02-1.10; P<.001). Conclusion: WC, but not BMI, is predictive of long-term mortality in elderly individuals with CHF and to a lesser extent in those without CHF.